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Should Dentists Take Safety Advice from Pilots?

What in the world do pilots have in common with dentists? Well, according to a dental professor at the University of Michigan and two pilot-dentists (there’s a new phrase for you), if dental office staff implemented a similar checklist of safety procedures used by airlines, they could drastically reduce human errors.

Pilots and dentists both engage in highly technical work that requires teamwork. And both are subject to human error where small, individual mistakes may lead to catastrophe if not addressed early. That means that dentists might benefit if they used the same type of safety procedures that pilots currently use.

Russell Taichman, U-M dentistry professor and director of the Scholars Program in Dental Leadership; Harold Pinsky, a full-time airline pilot and practicing general dentist; and David Sarment, a pilot and former U-M dental faculty member coauthored a study that focused on adapting airline crew resource management (CRM) principles to dentistry.

According to the researchers, airlines implemented CRM about 30 years ago after recognizing that most accidents resulted from human error. While implementing similar CRM checklists in the dentist’s office might represent a major culture shift that will be slow to catch on, the researchers think it could help – and that it's inevitable.

"It's about communication," Pinsky said. “If I'm doing a restoration and my assistant sees saliva leaking, in the old days the assistant would think to themselves, ‘The doctor is king, he or she must know what's going on.'" But if all team members have a CRM checklist, the assistant is empowered to tell the doctor if there is a problem.

At each of the five stages of the dental visit, the dental team using a CRM system would be responsible for checking safety items off a codified list before proceeding. Pinsky said that while he expects each checklist to look different for each office, the important thing is to have the standards in place.

Studies show that CRM works, the researchers added. Six government studies of airlines using CRM suggest safety improvements as high as 46 percent. Another study involving six large corporate and military entities showed accidents decreased between 36 and 81 percent after implementing CRM. In surgical settings, use of checklists has reduced complications and deaths by 36 percent.

Many other industries, such as hospitals, emergency rooms and nuclear plants look to the airline industry to help craft CRM programs. Dentistry, however, hasn't adopted CRM. Sarment pointed out that in his practice, “Using checklists makes for a safer, more standardized routine of dental surgery.”

This study will appear in the August issue of the Journal of the American Dental Association.